Please complete, print, and sign this gift form to provide necessary information to complete the transfer of a gift of stock to the American Health Assistance Foundation (Federal ID # 23-7337229). This form may also be used to instruct the donor's broker to electronically transfer a stock gift. When the stock is transferred, this form can be faxed to:
Gayle Handiboe Fax: (301) 258-9454
Donors Name and Address
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
[ ] Donor wishes to remain anonymous
Electronic Transfer Instructions
For instructions on how to transfer stock electronically, please contact:
Gayle Handiboe
Manager of Development
American Health Assistance Foundation
22512 Gateway Center Drive
Clarksburg, Maryland 20871
Fax: 301-258-9454
E-mail: ghandiboe@ahaf.org
Securities Donated
Date of Transfer_____________
Name of security________________________________________
Number of Shares_____________
Name of security________________________________________
Number of Shares_____________
Specific American Health Assistance Foundation Program to
which the gift should be donated:
Alzheimer's Disease Research
National Glaucoma Research
Macular Degeneration Research
Transferring Broker
Name_____________________________
Telephone__________________________
Firm______________________________
Address____________________________
____________________________
____________________________
Donations to the American Health Assistance Foundation
are tax-deductible under the Internal Revenue Code of the Internal Revenue Service
for computing income and estate taxes. The American Health Assistance Foundation
is a federally recognized 501(c)(3) non-profit, tax-exempt organization.
If you have any questions concerning this transfer, you may contact the Development Department at the American Health Assistance Foundation by calling 1-800-437-2423.